Liver Enzyme Levels High

[lizzyp]

I have had POTS for a year now. Last year my blood work was normal. This year my liver enzyme levels are elevated. I dont know if this is just me or if it could be a POTS related thing. Im going to a Gastroenterologist on April 15, but Im a little frieked out in the mean time.

[Sophia3]

Liver enzymes can often be elevated in healthy people and do not point to anything else going on. Sometimes a re-check will show normal and other times still elevated levels.

I know a woman who's husband NEVER DRANK or anything and had really high levels 20 years ago and at first had problems getting life insurance. Finally all else was normal and they believed he never drank.

He was a strict Baptist and had grown up with boozehound father so he NEVER drank.

Sometimes its just a genetic quirk. A girlfriend of mine had a similar thing years ago. She is still fine and healthy. I think with so many folks getting them checked we are realizing they can sometimes mean something benign as well as something else going on.

Of course you should follow thru with the doctor to rule out things but I did want to share that I have heard of this happening several times and can often just be a quirk. Certainly something to keep an eye on but many folks live healthy years with up and down elevations.

Let us know when you get more follow up. If you are concerned, ask them to prob your abdomen or even ask for a scan if it bothers you. Nothing wrong with getting an ultrasound for peace of mind.

[mae]

Hi,

That has been my only abnormal bllod tests since I've been dealing with my illness. Recently had liver ultrasound was normal so maybe its POTS related not sure yet just letting you know I have the same problem and it goes from normal to elevated pretty much every month.

Mae

[Miriam Poorman-Knox]

Abnormal liver enzymes are also associated with NASH non-alcoholic steado hepatitis. It is good to check out. M

[pearsjon]

can also be from rx's.

[all4family]

I was checked for hepatitis like 4 times due to high liver enzymes....I believe mine was related to the medictions I had taken as I don't metabolize them correctly. My billy tot and billy ruben were high, and my urine was a lovely shade of brown. Miriam what is NASH?

Suzy

[juliegee]

Mine have been intermittently very high off and on. I was even hospitalized with hepatitis (which i didn't have in my late 20's- long story!) In retrospect, my liver enzymes go up when my gallbladder is acting up. Are you also having pain in your upper abdomen or between your shoulder blades? As far as I know, my high liver enzymes have resolved with my gallbladder removal. GB things started acting up on my late 20's. I was very thin and had no risk factors. Just a possible cause....

Julie

[all4family]

Julie,

I have pain in my upper abdomen, and between my shoulder blades. But the pain is on the left. I have had my gallbladder ultrasounded several times, but it is always ok. Didn't you say on another post that your gallbladder ultrasounds were all ok? And is the pain for gallbladder on the right? Thanks in advance.

Suzy

[Broken_Shell]

Hi,

How elevated are the levels? As someone mentioned, this can be caused my certain medications or transient illnesses. Hopefully the GI doctor will be able due some more extensive work-up. How elevated were the values? I have had elevated pancreatic enzymes for the past several years (about 3X upper limit of normal) but nobody seems to know whether or not it means anything. I have had several mri's that show my pancreas is "enlarged", but I don't appear to have any symptoms of pancreatitis or pancreatic cancer, so it is just something that everyone likes to make note of, but beyond that it just falls in the "not sure what to do about this" category.

Let us know how your appointment with the GI doctor goes.

~ Broken_Shell

[pat57]

The GI Dr. is the place to go . There is a story in the numbers. How high one is compared to another.

http://www.righthealth.com/topic/Enzymes_L..._function_tests

Standard liver panel

This section is missing citations or needs footnotes. Please help add inline citations to guard against copyright violations and factual inaccuracies. (November 2008)

Measurement Significance Reference range

Alanine transaminase (ALT) Alanine transaminase (ALT), also called Serum Glutamic Pyruvate Transaminase (SGPT) or Alanine aminotransferase (ALAT) is an enzyme present in hepatocytes (liver cells). When a cell is damaged, it leaks this enzyme into the blood, where it is measured. ALT rises dramatically in acute liver damage, such as viral hepatitis or paracetamol (acetaminophen) overdose. Elevations are often measured in multiples of the upper limit of normal (ULN). 5 to 40 IU/L [1]

Aspartate transaminase (AST) Aspartate transaminase (AST) also called Serum Glutamic Oxaloacetic Transaminase (SGOT) or aspartate aminotransferase (ASAT) is similar to ALT in that it is another enzyme associated with liver parenchymal cells. It is raised in acute liver damage, but is also present in red blood cells, and cardiac and skeletal muscle and is therefore not specific to the liver. The ratio of AST to ALT is sometimes useful in differentiating between causes of liver damage.[2][3] Elevated AST levels are not specific for liver damage, and AST has also been used as a cardiac marker. 10 to 40 IU/L [1]

Alkaline phosphatase (ALP) Alkaline phosphatase (ALP) is an enzyme in the cells lining the biliary ducts of the liver. ALP levels in plasma will rise with large bile duct obstruction, intrahepatic cholestasis or infiltrative diseases of the liver. ALP is also present in bone and placental tissue, so it is higher in growing children (as their bones are being remodelled) and elderly patients with Paget's disease. 30 to 120 IU/L [1]

Total bilirubin (TBIL) Bilirubin is a breakdown product of heme (a part of haemoglobin in red blood cells). The liver is responsible for clearing the blood of bilirubin. It does this by the following mechanism: bilirubin is taken up into hepatocytes, conjugated (modified to make it water-soluble), and secreted into the bile, which is excreted into the intestine.

Increased total bilirubin causes jaundice, and can signal a number of problems:

* 1. Prehepatic: Increased bilirubin production. This can be due to a number of causes, including hemolytic anemias and internal hemorrhage.

* 2. Hepatic: Problems with the liver, which are reflected as deficiencies in bilirubin metabolism (e.g. reduced hepatocyte uptake, impaired conjugation of bilirubin, and reduced hepatocyte secretion of bilirubin). Some examples would be cirrhosis and viral hepatitis.

* 3. Posthepatic: Obstruction of the bile ducts, reflected as deficiencies in bilirubin excretion. (Obstruction can be located either within the liver or in the bile duct.)

2 - 14 mol/L

Direct bilirubin The diagnosis is narrowed down further by looking at the levels of direct bilirubin.

* If direct (i.e. conjugated) bilirubin is normal, then the problem is an excess of unconjugated bilirubin, and the location of the problem is upstream of bilirubin excretion. Hemolysis, viral hepatitis, or cirrhosis can be suspected.

* If direct bilirubin is elevated, then the liver is conjugating bilirubin normally, but is not able to excrete it. Bile duct obstruction by gallstones or cancer should be suspected.

0 - 4 mol/L

Gamma glutamyl transpeptidase (GGT) Although reasonably specific to the liver and a more sensitive marker for cholestatic damage than ALP, Gamma glutamyl transpeptidase (GGT) may be elevated with even minor, sub-clinical levels of liver dysfunction. It can also be helpful in identifying the cause of an isolated elevation in ALP. GGT is raised in alcohol toxicity (acute and chronic). In some laboratories, GGT is not part of the standard LFTs and must be specifically requested. 0 to 51 IU/L [1]

[edit] Other tests commonly requested alongside LFTs:

Pathophysiology sample values BMP/ELECTROLYTES:

Na+=140 Cl-=100 BUN=20 /

Glu=150

K+=4 CO2=22 PCr=1.0 \

ARTERIAL BLOOD GAS:

HCO3-=24 paCO2=40 paO2=95 pH=7.40

ALVEOLAR GAS:

pACO2=36 pAO2=105 A-a g=10

OTHER:

Ca=9.5 PO4=1 Mg2+=2.0

CK=55 BE=-0.36 AG=16

SERUM OSMOLARITY/RENAL:

PMO = 300 PCO=295 POG=5 BUN:Cr=20

URINALYSIS:

UNa+=80 UCl-=100 UAG=5 FENa=0.95

UK+=25 USG=1.01 UCr=60 UO=800

PROTEIN/GI/LIVER FUNCTION TESTS:

LDH=100 TP=7.6 AST=25 TBIL=0.7

ALP=71 Alb=4.0 ALT=40 BC=0.5

AST/ALT=0.6 BU=0.2

AF alb=3.0 SAAG=1.0 SOG=60

CSF:

CSF alb=30 CSF glu=60 CSF/S alb=7.5 CSF/S glu=0.4

[edit] 5' nucleotidase (5'NTD)

5' nucleotidase is another test specific for cholestasis or damage to the intra or extrahepatic biliary system, and in some laboratories, is used as a substitute for GGT for ascertaining whether an elevated ALP is of biliary or extra-biliary origin.

[edit] Coagulation test (e.g. INR)

The liver is responsible for the production of coagulation factors. The international normalized ratio (INR) measures the speed of a particular pathway of coagulation, comparing it to normal. If the INR is increased, it means it is taking longer than usual for blood to clot. The INR will only be increased if the liver is so damaged that synthesis of vitamin K-dependent coagulation factors has been impaired: it is not a sensitive measure of liver function.

It is very important to normalize the INR before operating on people with liver problems (usually by transfusion with blood plasma containing the deficient factors) as they could bleed excessively.

[Miriam Poorman-Knox]

I was checked for hepatitis like 4 times due to high liver enzymes....I believe mine was related to the medictions I had taken as I don't metabolize them correctly. My billy tot and billy ruben were high, and my urine was a lovely shade of brown. Miriam what is NASH?

Suzy

Non-Alcoholic Steado Hepatitis. I have this. It can be a result of meds or other isues that don't include alchohol. You can google it. I see "liver dude" and I think it important to f/u on. Its different than other hepatitises. Not contageous.... Sorry about spelling only 1 cup of coffee. M

[all4family]

Thank you Miriam, I will add that to my list of things to google today! Ha Ha!! Isn't the internet grand?

Suzy

[ramakentesh]

LOL = mine have been elevated - but my doc assumes this is from eating unpasturised cheese in mexico because i tested positive to some bizarre version of hepatits they call hepatitis E or X or something - its an acute form anyway.

Not much fun, but I was amazed how much people felt more sorry for me when i said i had that than when i tell them about POTS which at its worst is far worse than hepatitis E.

[firewatcher]

Never had my liver enzymes tested, but I can testify to the pain of a useless gallbladder! Mine was perfect and plump and stone-free, it just did not drain! It would swell with bile and sit there, it functioned at less than 17%. I think 30% is the limit for getting that little booger yanked out! I really had to insist on a function test, since nothing else pointed to that other than family history. I felt so much better with it gone! Even the surgeon made a comment on there being nothing "wrong" with it...but there was nothing right either! And gee, since the surgery 10 years ago, I haven't had the pain, hmmm.

[ramakentesh]

Well this has been pretty strange for me. Ive been extensively re-tested and now they couldnt find any form of hepatitis in me and after 10 months and 1 night of 2 beers and 1 week of anti inflammatories for my sore back my liver frunction tests are still elevated - in the past I had high Bilirubin, Alkaline phostpate and Albumin.

Now also my ALT was mildly elevated.

Weird...

[Guest tearose]

I thought my NASH was just an incidental finding. I don't do anything for it. I have never been able to handle alcohol so I was surprised that I had this finding.

I am of italian descent with odd shaped red cells so perhaps that is what is taxing my liver.

[pat57]

being over weight can cause "fatty liver" and effect tests.

also

"Hemochromatosis occurs when too much iron builds up in the body, particularly the liver. The result is liver swelling.

There are two forms of hemochromatosis: primary and secondary.

Primary hemochromatosis is caused by a problem with your genes or by receiving a large number of blood transfusions which boost your iron levels. Primary hemochromatosis is the most common genetic disorder in the United States, affecting an estimated 1 of every 200 to 300 Americans."

[Brye]

I have POTS and mine were elevated this last ER visit. I need to have them rechecked in about 3 months to make sure they aren't rising at all. For me I 'm thinking maybe from all the meds or recent weight gain.

Brye

[ramakentesh]

I had a stomach bug in mexico last year but im now talking 14 months ago...pretty strange. I rang the gastro and im sure he wont return my calls... LOL

[Serbo]

Hi gang, just to bump this old thread. I have had elevated isolated ALT for a few months now. Top of the range here in the UK for normal is 52. It sat around 62, for a while, then went up to 90, 113 and now sitting steadily @ 90. All other liver enzymes and bloods are fine. Liver ultrasound is normal. Had Hepatitis as a child so got gut bacteria blood test done and waiting for results.

Doctors are puzzled as to what's causing it, but aren't worried.I am on a PPI drug called Omeprazol and there are cases where it has caused elevated but stable liver enzymes. Anyone else had this drug do something similar?

Doctors will not take you off a Gastro drug for elevated liver enzymes until your 3 times over the range, as I'm not even once over yet I have to stay on it.

If i miss even 1 dose of Omeprazol i feel terrible, anxious, sick etc, desperate to get off it. I hear long term users of it have the same issues when they try and stop it.

[sandymbme]

I don't know what other medications you may be on, but I had elevated liver enzymes that we initially thought was due to the medication Cymbalta, although it turned out to be due to a problem with my common bile duct, as we found when I had an ERCP. So since you have both gastro issues and from the sounds of it some panic, I thought I would mention my experience to see if either one of those options might give you some insight. For what it was worth, the ended up having to put a stent in that common bile duct, and it was not something that showed up on my abdominal CT or other imaging tests. And Cymbalta, and other anti-depressants in the same class of drugs can cause liver enzymes to elevate, sometimes so badly that you have to be removed from the drug immediately. Before they had did the ERCP, they stopped my Cymbalta cold turkey, which was the most miserable experience of my life. PM me if you have more questions.

Sandy

[Serbo]

Thanks Sandy, seeing a Neurogastroentologist next week so hope the tests he orders can shed some light on it

[ramakentesh]

I also have abnormal liver enzymes. My doc assumed it was to do with Ankylosing Spond. I haev had viral hepatitis in the past from Mexico (Hepatitis E)

[Serbo]

I also have abnormal liver enzymes. My doc assumed it was to do with Ankylosing Spond. I haev had viral hepatitis in the past from Mexico (Hepatitis E)

Interesting, i had hep A as a child.

My GP emphasised isolated liver enzyme rises are normal in the sense that it's common. I managed to get athletes floor or similar, treating it with daktacort which is helping, and alo liver enzyme has gone back to normal. Possibly a co incidence, but an interesting observation.